CRICOS No 00213J The First National Conference on Alcohol Consumption and Related Problems in Thailand “Alcohol Situation, Trend, Threat and Policy” Bangkok 13 th to 15 th July 2005

Alcohol interventions: development of a rehabilitation program for drink driving offenders Prof Mary Sheehan Centre for Accident Research and Road Safety – Queensland Queensland University of Technology

Content of Presentation  Background  Defining the drink driving offender  Defining the problem  Targeting successful drink driving programs  Psychosocial Treatment models for Alcohol Dependency  “Under the Limit 1”: a prototype  “Under the Limit 2”  Overview

The context of drink driving Theoretical Model of Tiers of Influence on Drink Driving Behaviour

Alcohol levels & Drink Driving Association Percentage of fatally injured drivers and motorcycle riders with a BAC of 0.05gms/100ml or greater in Australia, 1981 to 1998, and total litres of pure alcohol consumed by Australians per capita Total litres of alcohol consumed %

Defining the drink driving offender (1 ) Methods for determining alcohol impairment a)‘Per Se’ → BAC → Impaired driving OR b)Impaired Driving → BAC

Defining the drink driving offender (2) Offence severity index combines BAC and number of offences BAC Offences (+) 25-30% Alternative is ‘hard core’ offender and ‘others’

Drink Driver Characteristics  More likely to belong to a heavy drinking subculture that accepts drink driving  Majority male  Aged between 20 – 39 years  Have a history of convictions  Have poor employment and literacy histories

Targeting successful drink driving rehabilitation programs Program Goals  Challenge and educate regarding unsafe driving associated with alcohol consumption  Challenge and change alcohol use Program Approaches  Education or information based  Psychotherapy / counselling based  Combination of above Success defined as reducing drink driving recidivism usually measured by time to re-offence

Characteristics of successful programs Content  Education and information on effect of alcohol on driving skills  Estimating personal alcohol consumption and associated BAC (as measure of impairment)  Targeting reducing alcohol consumption  Use cognitive, social and behavioural focus on both alcohol use and drink driving Process  Target high-risk offenders  Target the offence behaviour  Are community based  Structural with clear objectives and content  Use directive approach or style  Intervention integrity – is delivered as designed Combination rehabilitation programs in association with licence restrictions and probationary supervision

Psychosocial treatments for alcohol dependency  Address motivation and self-efficacy skills  Teach coping and other social and behavioural skills  Modify reinforcement contingencies  Foster management of negative emotions  Improve interpersonal functioning  Foster adherence to pharmacotherapy MATCH, 2002 & UKATT, 2004

Under the Limit 1: a prototype Process  11 weekly sessions  A contract signed to: come on time all homework completed not to drive to or from the session come to session free of alcohol attend all sessions  A diary and other homework activities must be completed weekly  A support person enlisted to help with change  All sessions have focus, objectives, key activities and expected outcomes explicitly presented and discussed  Directed interactive learning experience

Under the Limit 1: a prototype Content Core Elements  Controlled drinking strategies and skills  Information on hazards related to drinking and driving  Training in skills and strategies to avoid future drink driving  Developing social and behavioural skills and change strategies around ‘who, where, when and how much?’ drinking occurs

Under the Limit 1 – a prototype Facilitators Aim to maximise social context change using community leaders as facilitators Community Health Nurse TAFE Teacher Principal Secondary School Retired Police Officer Taxi Driver Family Services Officer Proprietor – Small Business Driving School Proprietor Director – Day Care Centre Secondary School Teacher Primary School Teacher University Lecturer Youth Worker Tax Officer Defensive Driver Trainer Physical Education Teacher Physical Therapist Community Development Officer Computer Programmer Drug and Alcohol Counsellor

Under the Limit 2 Under the Limit 1 and Alcohol Ignition Interlock  Training in how it works  What it does  How it can help avoid future drink driving

Overview Distal/ situational influences Manage Alcohol Access / RBT Proximal Influences Rehabilitation / Social Skills Personal Characteristics Rehabilitation / Behaviour Change BehaviourInterlocks/ RBT Drink driving At Risk Acquaintances, Family, Peers Social Context